Abstract: Protecting the privacy of individually-identifiable health data is a dominant health policy objective in the new millennium. The genesis of many modern privacy protections derive from historical efforts to legally and ethically frame and respect individual privacy interests. This article examines historical traditions in health information privacy and modern privacy norms and the privacy rules pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We begin by raising a few salient themes in the legal and ethical traditions of protecting health information privacy in the United States. What is the tradition of confidentiality regarding public health activities? How does this compare to the tradition of medical confidentiality? Within this schematic, we consider the genesis of privacy norms, the prevalent social mores that informed these histories, supporting ethical codes, early 20th century state public health law, and the influence of the principle of autonomy upon health information privacy. We then provide a modern synthesis of the HIPAA Privacy Rule to inform our discussion of whether two modern privacy norms (i.e., the premise of balancing and the foundation of informed consent) are historically grounded and reflect sound privacy policy.
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